Assessment of Left ventricular function in coronary slow flow by two-dimensional speckle tracking dobutamine stress Echocardiography

Main Article Content

Haidy Sherif Elhagin, Reda Biomy, Mohamed Kamal Salama, Mohamed S. Elsherbeni, Wael A. Haseeb

Keywords

Dobutamine; Stress Test; Coronary slow flow; Ischemia; Echocardiography; Speckle tracking

Abstract

The Coronary Slow Flow Phenomenon (CSFP) is defined as delayed distal vessel contrast opacification without any evidence of obstructive epicardial coronary artery disease. Medical literature contains conflicting data regarding the effects of CSFP on left ventricular functions assessed by conventional echocardiography or tissue Doppler imaging.


Material and methods: Patients with chronic stable angina were referred for coronary angiography from February 2022 to December 2022 at the Department of Cardiology, Faculty of Medicine, Kafrelsheikh University Hospitals. 50 patients with CSFP and 50 age-and-sex-matched controls without CSFP were enrolled in the study. CSFP was diagnosed by TIMI Frame Count (TFC). GLS of LV was measured by two-dimensional (2D) STE in addition to other conventional and tissue Doppler parameters to assess LV diastolic and systolic functions.


Results: LV GLS was lower in CSFP group patients (–15 ±2.73) compared to the control group (–17.19 ±2.54) (p=0.001). There was a statistically significant negative correlation between mean TFC and LV GLS (r=–0.33, p=0.002). LVEF by the modified Simpson method was lower in the CSFP group (57.77 ±5.66%) compared to the control group (59.29 ±3.32%) but with no statistical significance (p=0.18). Left atrial diameter LAVI was larger in the CSFP group compared to the control group (p


Conclusions: CSFP impairs LV systolic and diastolic function, using 2D speckle tracking dobutamine stress echocardiography; the most pivotal findings reveal that dynamic assessments under different dobutamine infusion rates highlighted substantial alterations in left ventricular function. Specifically, left ventricular strain (LS), strain rate during systole (LSRs), and strain rate during early diastole (LSRed) demonstrated significant differences across varying infusion rates, with notable decrements in LS and LSRs as dobutamine dosage increased.

Abstract 22 | PDF Downloads 15

References

1- Beltrame JF, Limaye SB, Horowitz JD. The coronary slow flow phenomenon--a new coronary microvascular disorder. Cardiology 2002; 97(4): 197-202. http://dx.doi.org/10.1159/000063121 PMID: 12145474

2- Montalescot G, Sechtem U, Achenbach S, et al. Task Force Members; ESC Committee for Practice Guidelines; Document Reviewers. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34(38): 2949-3003. http://dx.doi.org/10.1093/eurheartj/eht296 PMID: 23996286

3- Mangieri E, Macchiarelli G, Ciavolella M, et al. Slow coronary flow: Clinical and histopathological features in patients with otherwise normal epicardial coronary arteries. Cathet Cardiovasc Diagn 1996; 37(4): 375-81. http://dx.doi.org/10.1002/(SICI)1097-0304(199604)37:43.0.CO;2-8 PMID: 8721694

4- Saya S, Hennebry TA, Lozano P, Lazzara R, Schechter E. Coronary slow flow phenomenon and risk for sudden cardiac death due to ventricular arrhythmias: A case report and review of literature. Clin Cardiol 2008; 31(8): 352-5.

5-WANG Y., MA C., ZHANG Y., GUAN Z., LIU S., LI Y., et al.: Assessment of Left and Right Ventricular Diastolic and Systolic Functions Using Two-Dimensional SpeckleTracking Echocardiography in Patients with Coronary Slow-Flow Phenomenon. PLoS ONE, 10 (2): e0117979, 2015.

6- WANG X. and NIE S.: The Coronary Slow Flow phenomenon: Characteristics, mechanisms and implications. Cardiovasc. Diagn. Ther., 1: 37-43, 2011.

7- MARECHAUX S.: Speckle-tracking strain echocardiography: Any place in routine daily practice in 2014? Arch. Cardiovasc. Dis., 106: 629-34, 2013.

8- MOR-AVI V., LANG R.M., BADANO L.P., BELOHLAVEK M., CARDIM N.M., et al.: Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur. J. Echocardiogr., 12: 167-205, 2011.

9- Abawi, D., Rinaldi, T., Faragli, A., Pieske, B., Morris, D. A., Kelle, S., et al. 2022. The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications. Heart Fail Rev, 27, 1261-1279.
10-Aparicio, A., Cuevas, J., Morís, C. & Martín, M. 2022. Slow Coronary Blood Flow: Pathogenesis and Clinical Implications. Eur Cardiol, 17, e08.
11-Dokainish, H. 2015. Left ventricular diastolic function and dysfunction: Central role of echocardiography. Glob Cardiol Sci Pract, 2015, 3.
12-Dong, T., Zhu, Q., Wang, S., Liu, S., Wang, S., Wang, Y., et al. 2023. Evaluation of left ventricular function in patients with coronary slow flow: A systematic review and meta-analysis. Cardiol J, 30, 929-37.
13-Dubin, A., Lattanzio, B. & Gatti, L. 2017. The spectrum of cardiovascular effects of dobutamine - from healthy subjects to septic shock patients. Rev Bras Ter Intensiva, 29, 490-498.
14-Farag, S. I., El-Rabbat, K. E. E., Ahmed Mostafa, S., Abd Alnaby, M. S. & Sabry, A. M. 2020. The predictive value of speckle tracking during dobutamine stress echocardiography in patients with chronic stable angina. Indian Heart J, 72, 40-45.
15-Hanafy, A., Soliman, A., Elsaughier, S. M., Mansour, H.-E., Salama, M. K., Gharib, S., et al. 2022. Potential prediction of myocardial viability using strain/strain rate at low-dobutamine stress echocardiography on a segment-by-segment basis. The Egyptian Journal of Hospital Medicine, 88, 2503-2511.
16-Kleb, C., Jain, V., Sheth, C., Wolski, K., Kapadia, S., Grimm, R., et al. 2021. Comparison of Coronary Artery Calcium Scoring with Dobutamine Stress Echo for Detection of Coronary Artery Disease Before Liver Transplantation. Ann Transplant, 26, e934163.
17-Lin, Y., Guan, X., Ren, K., Zhu, Y., Lu, Y. & Shang, Y. 2020. Low-dose dobutamine stress myocardial contrast echocardiography for the evaluation of myocardial microcirculation and prediction of overall cardiac function recovery. Exp Ther Med, 20, 1315-1320.
18-Liu, B. Y., Wu, W. C., Zeng, Q. X., Liu, Z. H., Tian, Y., Niu, L. L., et al. 2019. EXPRESS: Left ventricular early diastolic strain rate detected by two-dimensional speckle tracking echocardiography and disease severity in pre-capillary pulmonary hypertension. Pulm Circ, 9, 2045894019865158.
19-MacGowan, G. A., Du, C. & Koretsky, A. P. 2001. High calcium and dobutamine positive inotropy in the perfused mouse heart: myofilament calcium responsiveness, energetic economy, and effects of protein kinase C inhibition. BMC Physiol, 1, 12.